LAC DPH Health Advisory: Addressing Low COVID-19 Vaccination Rates in Children 5-11 Years of Age January 28, 2022 American Academy of Family Physicians, American Academy of Pediatrics, CDC, Centers for Medicare and Medicaid Services, COVID-19, hospitalizations, LA County, LAC DPH, LAHAN, Los Angeles, Los Angeles County, Providers, Resources, vaccination rates, Vaccine, Vaccine Safety 1616 Key Messages The CDC, the American Academy of Family Physicians, and the American Academy of Pediatrics recommend that all children ages 5 years and older should be vaccinated against COVID-19 to prevent both short- and long-term health complications. Only 29% of children ages 5-11 in Los Angeles County have received one dose of vaccine and only 19% are fully vaccinated. There are wide disparities in vaccination rates (11%-95% by ZIP Code) with lower rates generally in resource-poor communities that have been disproportionately impacted by COVID-19. Research has shown that pediatricians remain the most trusted source of information regarding COVID-19 vaccines for hesitant parents. Resources are available to help address vaccine hesitancy. The Centers for Medicare and Medicaid Services are now providing reimbursement for COVID-19 vaccine counseling visits for children, even if vaccine is not directly administered. Healthcare providers are urged to contact their patients’ parents/legal guardians and strongly recommend that their children get fully vaccinated (if they are 5 years and older) and a booster dose when due (if they are 12 years and older). Sample letters that practices can tailor and sent to parents are available in the Resources for Communicating with Parents section of the LAC DPH Vaccine Hub. Situation During the last month, Los Angeles County has experienced record numbers of COVID-19 cases, leading to increased COVID-19-related hospitalizations in all age groups. Specifically, hospitalizations among children aged 5-11 years with COVID-19 are the highest since the beginning of the pandemic, increasing from 2 cases/week mid-November 2021 to 23 cases/week in mid-January 2022 (figure 1). Most of the recent hospitalizations among this age group in LA County have been among children who were not fully vaccinated. Among the 49 children aged 5-11 hospitalized from January 1 through January 20, only 4 were fully vaccinated for COVID-19 (LAC DPH unpublished data). The average age of children in LA County with Multisystem Inflammatory Syndrome in Children (MIS-C) is 8 years of age. See Reported MIS-C Cases Associated with COVID-19 in LA County, 2020-2022. Figure 1. Number of 5- through 11-year-olds with COVID-19 admitted to hospitals in Los Angeles County, by admission date.* *This includes admissions due to COVID-19 related illness and COVID-19 infection detected through screening. Vaccine safety and effectiveness On November 2, 2021, the Advisory Committee on Immunization Practices (ACIP) reviewed clinical trial data showing that the Pfizer-BioNTech (“Pfizer”) vaccine is safe and effective at preventing COVID-19 in children 5-11 years of age. They recommended that children in this age group receive a 2-dose series of Pfizer pediatric vaccine. An MMWR on December 31, 2021, reported that as of December 19, over 8.7 million doses of Pfizer vaccine had been administered to this age group and serious adverse events were rarely reported. Furthermore, data suggests that COVID-19 vaccination remains highly protective against hospitalizations and long-term complications, including Multi-system Inflammatory Syndrome in Children. On January 5, 2022, the ACIP also reviewed safety data in children using three different systems, the Vaccine Safety Datalink, v-safe, and the Vaccine Adverse Events Reporting System, as well as vaccine effectiveness data, which again showed that this vaccine is safe and effective. Additional doses and booster doses It is recommended that individuals age 5 and older who are moderately or severely immunocompromised should get an additional primary dose of mRNA vaccine 28 days after their second dose because they may not respond adequately to a two-dose series. A booster dose is recommended for everyone age 12 and over given the reassuring vaccine safety data and the emerging evidence that a booster dose significantly increases protection against infection with the Omicron variant. It is recommended that youth ages 12-17 receive a single Pfizer vaccine dose at least 5 months after completing the primary series, and people age 18 and over receive either a Pfizer or Moderna booster. See Provider COVID-19 Vaccine Eligibility Summary Table. Low vaccination rates in 5- through 11-year-olds with wide variation by ZIP Code Despite the demonstrated safety and efficacy of the Pfizer vaccine in children and the unprecedented surge in COVID-19 cases, vaccination rates continue to be low in children aged 5-11 years. In Los Angeles County, only 29% have received a first dose compared to 83% of 12- through17-year-olds. In addition, first dose rates for 5- through11-year-olds by ZIP Code vary considerably, from 11% to 95%, with the lowest rates generally in resource-poor communities that have been disproportionately impacted by COVID-19. Booster dose uptake among 12-through 17-year-olds is also low. View the LA County COVID-19 Vaccine Data Dashboard for more details. Vaccine acceptance Parental concerns about COVID-19 vaccination include potential unknown long-term health issues, side effects, and that the vaccine is too new, as well as not being worried about COVID-19 or thinking that the vaccine is unnecessary. Per Kaiser Family Foundation, pediatricians are the most trusted source of information on the COVID-19 vaccine for 77% of parents, yet only 37% of parents of children ages 5 to 11 say they have spoken with their child's pediatrician about the COVID-19 vaccine. Many resources are available to help providers address these concerns during conversions with patients (see below). To better protect children and address inequities in COVID-19 vaccine uptake, we are urging providers to take action. Actions Requested of Providers Consider enrolling to become a COVID-19 vaccine provider. Please contact the LAC DPH vaccine on-boarding team with questions or for support at: COVAXonboard@ph.lacounty.gov. Contact the parents/caregivers of patients 5 years of age and older and: Urge and them to get their child(ren) up to date with their vaccines (i.e., complete a primary vaccine series and get a booster as soon as they are eligible). Note that children who have recently been infected with COVID-19 can get a vaccine (including a booster) as soon as their acute illness has resolved and they have completed isolation. Tell them how access COVID-19 vaccines. Vaccines are widely available across LA County, including at DPH vaccine sites, pharmacies, school-based vaccine clinics and other trusted sources and many do not require an appointment. To search for a vaccine provider, by location and vaccine type, visit ph.lacounty.gov/VaccineAppointment or ph.lacounty.gov/CitaDeVacuna (Spanish). Sample letters that your practice can tailor are available in the Resources for Communicating with Parents section of the LAC DPH Vaccine Hub. These include both short and long versions for practices that offer COVID-19 vaccination and for practices that can provide guidance and referal for vaccination. Familiarize yourself with resources to address questions about COVID-19 vaccines as well as vaccine hesitancy. Resources include: Tuesday night pediatric provider office hours co-hosted by the AAP and LAC DPH addressing questions about COVID-19 vaccine ordering, handling, and administration. CDPH “30 Conversations in 30 Days” Campaign including how to have effective conversations with parents about COVID-19 vaccines for school- aged children and talking with patients in Latinx and Black communities about COVID-19 vaccines. AAP “ThisIsOurShot” toolkit LAC DPH Vaccine Community Resources (see below) CDC How to Talk with Parents and Caregivers about COVID-19 Vaccination Consider posting information about the importance of COVID-19 vaccine on your medical practice’s website and social media. See COVID-19 vaccine promotional resources for children and teens CDC | LAC DPH. Continue to report any suspected adverse events following receipt of any vaccine to the Vaccine Adverse Events Reporting System (VAERS). Vaccines are widely available across LA County. VaccinateLACounty.com (VacunateLosAngeles.com – Spanish) to find a location. Individuals can call 1-833-540-0473 if they need help making an appointment, need transportation to a vaccination site, or are homebound. Phone lines are open from 8am to 8:30pm 7 days a week. Information is also available in many languages 24/7 by calling 2-1-1. Resources LAC DPH Resources Sample Letter Templates COVID-19 vaccine resources for providers Eligibility summary table for providers - summarizes vaccine eligibility based on the primary series and patient age and/or risk factors Vaccination Hub Social media/webpage assets Pediatric provider office hours COVID-19 vaccine resources for patients These resources are available in multiple languages on the DPH Vaccine Community Resources subpage of VaccinateLACounty.com (Spanish - VacunateLosAngeles.com) Eligibility summary table for the public FAQs for parents Fact sheet for parents Fact sheet for teens CDC Resources Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States Resources to Promote the COVID-19 Vaccine for Children & Teens Visit the LAC DPH COVID-19 Hub and Vaccination Hub. Refresh your browser to view the latest version. This communication was sent by Dr. Nava Yeganeh, Medical Director, Vaccine Preventable Disease Control Program, Los Angeles County Department of Public Health To view a printable PDF of this communication and other LAHAN communications, please visit publichealth.lacounty.gov/lahan. If this message was forwarded to you, please join LAHAN here.